White blood cell levels high in 1 in 5 Cushing’s syndrome patients
Cells may be a 'predictor of remission' in Cushing's disease, researchers said
One person out of five with Cushing’s syndrome in Israel has higher than normal numbers of white blood cells that drop within two years after surgery, but may still remain higher than the general population, a study finds.Â
Patients with Cushing’s disease, a specific type of Cushing’s syndrome caused by a tumor in the brain’s pituitary gland, were less likely to fully recover after surgery, or achieve remission, if they had higher white blood cell counts before surgery.
In this scenario, white blood cells may be a “potential predictor of remission,” according to the researchers. The study, “Leukocytosis in Cushing’s syndrome persists post-surgical remission and could predict a lower remission prognosis in patients with Cushing’s disease,” was published in the Journal of Endocrinological Investigation.
Cushing’s syndrome occurs when there’s too much cortisol in the body. This can be caused by a pituitary tumor producing too much adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce cortisol. Excess ACTH can also come from a tumor elsewhere in the body and result in ectopic Cushing’s syndrome.
Excess cortisol can cause a wide range of symptoms and signs, including leukocytosis, or high white blood cell levels. Here, researchers evaluated how white blood cell counts change after surgery to treat Cushing’s syndrome.
White blood cells as predictor of remission
The study included data from 297 adults with Cushing’s syndrome, mostly women (72.7%), from Israel’s public healthcare system database. For 246 patients, the cause of Cushing’s syndrome was known: 127 had adrenal Cushing’s and 119 had Cushing’s disease. Patients with ectopic Cushing’s syndrome were excluded.
The researchers included 997 healthy people from the general population to serve as controls. On average, the patients were 3.1 years younger than the controls (51 vs. 54.1 years) and were more frequently diagnosed with hypertension, or high blood pressure (63.3% vs. 51.5%).
Leukocytosis occurred more frequently in patients before they had surgery than in the controls (21.5% vs. 8.9%). Likewise, on average, patients had significantly higher white blood cell counts — 8.8 vs. 7.54 thousand cells per microliter of blood.
The same was observed for neutrophils, a type of white blood cell that helps fight infections. The neutrophil-to-lymphocyte ratio (NLR), which is higher when there’s more inflammation in the body, was higher in patients (3.37 vs. 2.27). Lymphocytes are white blood cells that participate in the immune response.
Two years after surgery, the numbers of white blood cells decreased by 0.57 thousand cells per microliter. Those of neutrophils decreased by 0.84 thousand cells per microliter, which translated into a NLR decrease of 0.63. This suggests surgery may help treat leukocytosis.
Even after remission, however, the patients still had higher numbers of white blood cells, including neutrophils, than the controls (8.11 vs. 7.46 thousand cells per microliter). Here, remission was defined as cortisol staying within normal levels for 24 hours without medication or hormone replacement after surgery.
Among Cushing’s disease patients, those with higher white blood cell counts before surgery were less likely to achieve remission over those with normal counts (36.7% vs. 63.9%), suggesting that monitoring white blood cells may help predict the chance of successful treatment. This wasn’t observed for patients with adrenal Cushing’s syndrome, however.
“Leukocytosis, found in one out of five [Cushing’s syndrome] patients, may serve as a negative preoperative predictor of remission in [Cushing’s disease] patients, but not in [adrenal Cushing’s syndrome] patients,” the researchers wrote. “The correlation between leukocytosis and remission rates in patients with [Cushing’s disease], as well as the relationship between NLR and complication rates following treatment, warrants further investigation.”
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